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General NPI Number Information
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NPI Number | 1073129680
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Entity Type | Individual
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Provider Name | KIMBERLY SJOCKEIA SMITH-JONES
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Gender | Female
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 590 IRVINE TURNER BLVD
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City | NEWARK
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State | NJ
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Zip | 07112
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Country | US
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Telephone | 973-332-5096
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Fax |
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Provider Business Mailing Address
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Address Line | 2165 MORRIS AVE STE 21
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City | UNION
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State | NJ
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Zip | 07083-5913
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Country | US
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Telephone | 862-323-0942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18KT01258800
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License Number State | NJ
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